National Trends in Utilization and In-Hospital Outcomes of Bariatric Surgery
Abstracts
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Purpose: In view of recent enthusiasm for surgery to treat morbid obesity, we used national discharge data to examine changes in utilization and in-hospital outcomes of bariatric surgery over time. Methods: Using ICD-9 codes, we identified all bariatric procedures (n=12,203) performed on adults from 1990 to 1997 in hospitals participating in the Nationwide Inpatient Sample (NIS), the largest all-payer inpatient care database in the United States. We then applied sampling weights and US Census data to calculate the national population-based rate of bariatric surgery for each year and examine secular trends in utilization. We further examined the NIS cohort for changes in patient characteristics, in-hospital mortality, and peri-operative complications. Results: From 1990 to 1997, the national annual rate of bariatric surgery increased from 2.7 to 6.3 per 100,000 adults (p<0.001). The growth in utilization did not plateau during this period. We observed slight increases in mean patient age (38.1 to 40.3, p<0.01) and the proportion of patients with one or more major comorbidities (20.9% to 31.6%, p<0.001). However, in-hospital mortality (0.4% overall) remained stable over time. Overall rates of major respiratory complications (8.5%) and reoperations during the same admission for dehiscence, bleeding, or abscess (1.4%) also remained stable. Pulmonary embolus followed a declining trend but occurred infrequently (0.2% in 1990 to 0.08% in 1997, p=0.04). Median length of stay declined (5 to 4 days, p<0.01) while the proportion of patients with hospital stays over fourteen days (2.9% overall) did not change significantly. Conclusions: Between 1990 and 1997, the annual rate of bariatric surgery in the United States more than doubled, without substantial changes in peri-operative morbidity or mortality. Rates of bariatric surgical procedures may continue to increase due to the recent application of minimally invasive techniques, widespread publicity, and a large reservoir of potential patients. |
